Medical Journal News

An 81-year-old woman with a 2-day history of vomiting and abdominal distension attended our hospital. The patient reported no fever, recent travel abroad, or change of bowel habit. She had a 3-year history of dementia—diagnosed as Alzheimer's because she had presented with gradually declining short-term memory—and hysteromyoma resection at age 40 years; she was prescribed rivastigmine.

Almost 40 000 people died alone at home in Japan this year—many unnoticed for months—prompting much concern, and new policy. Megan Tatum reports.

Academic normsThe definition of a “norm” in the Oxford English Dictionary (OED) relevant to academic practice is “A standard or pattern of social behaviour that is accepted in or expected of a group.”1 In this case the group is the amorphous collection of academics, in whatever discipline they are involved.The relevant definition of an academic is “a member of a university or college's teaching or research staff.”2 However, there are individuals whom I would recognise as academics, working in institutions other than universities and colleges, for example, researchers in industrial companies of one sort or another. The definition needs to include those, and the OED offers what it calls a definition in a weakened sense, which I offer here in a slightly modified form: “a person interested in or excelling at pursuits involving reading, thinking, study, teaching, and research.” I have added the words “teaching” and “research,” and although I...

What drugs have been evaluated this year?This year the National Institute for Health and Care Excellence (NICE), the body that decides which treatments are available on the NHS, has rejected two new drugs for Alzheimer’s disease, lecanemab and donanemab, arguing that the small benefit they may provide does not outweigh the large cost of providing these drugs. This is partly due to the need to intensively monitor patients for side effects such as brain swelling and bleeding.1 Both drugs work by targeting β amyloid proteins in the brain that are thought to cause the disease.Although these drugs can still be provided through private healthcare providers, because they have been authorised by the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA), the approximate price tag of £20 000 a year means few people will be likely to be able to get them.However, their approval has sparked hope that new and effective...

In this episode of Sharp Scratch, the panel got together to discuss the many reasons why someone might take time out of medical school. They reflected on how decisions to take time out are often viewed negatively by others, and why taking time out can be beneficial, regardless of the reason behind it. In this episode, the panel, Éabha and Nat, were joined by Kate Owen, who is director of medical studies and professor of education at Warwick Medical School.Episode backgroundMedical school is an intense time, and inevitably, there are periods when some students want, or need, to take an extended break from their studies. This could be for a huge number of reasons—financial, medical, or maternity leave or caring responsibilities. In this episode, we discussed our personal experiences of taking time out, the impact of burnout, and the stigma associated with taking a break from our studies.Our guest, Kate,...

Access to the UK’s rich and vast banks of health data should be streamlined and simplified, to capitalise on the unique opportunity it offers to boost biomedical research and improve lives, a major review has recommended.The independent review led by neurologist Cathie Sudlow was commissioned by England’s chief medical officer to examine how to overcome barriers and inefficiencies in the secure use of health data across the four UK nations, with a focus on England.1The UK has one of the world’s largest and deepest health databases that stretches back decades. The report points out that, besides being used for patient care, the data are also used to support the delivery of equitable health and care, as well as research and innovation.Data relevant to health also come from sources beyond the NHS. The review argues that, to fulfil the potential of health data to improve lives, governments should collate data on...

The Medical Protection Society has called for all NHS trust staff who deal with disciplinary investigations to have specialised training, to ensure that doctors are treated fairly and compassionately, after data indicated that more than a third of trusts don’t make such training mandatory.The MPS sent requests under freedom of information legislation to 145 NHS trusts in England, asking for details about disciplinary procedures, including what training case managers receive, and received 86 responses (59% response rate).A third of trusts that answered the question on training (26 of 74) said they did not have mandatory training for staff who handling disciplinaries, while 23% (17 of 75) said they did not regularly submit data on disciplinaries to trust boards for scrutiny.Rob Hendry, MPS medical director, said that specialised training for staff would ensure that trusts had an “adequate understanding of employment law, the MHPS [Maintaining High Professional Standards] framework, and patient...

Toxicologists have warned of a sharp rise in drug overdose deaths in England involving a group of potent synthetic opioids called nitazenes.Nitazenes have been found as contaminants in street heroin and cocaine as well as black market vaping liquids and fake prescription drugs purchased online. New forms of nitazenes are emerging with one thought to be more than 300 times more potent than morphine and 45 times more than fentanyl.The Toxicology Unit at Imperial College, London, conducts toxicology analysis on behalf of coroners in London and Suffolk, handling approximately 2500 cases a year. The unit screens for nitazenes in the blood of all postmortem cases with a history of, or toxicological results indicating, drug misuse.Between 1 January and 31 December 2023 the unit reported 26 postmortem cases containing one or more nitazenes. Between 1 January and the middle of October 2024 the unit had already reported 95 deaths involving nitazenes.1...

The literature on development of clinical guidelines generally accepts that patients and carers should be involved in the process.123 Patients contribute subjective and practical knowledge of a condition, including what it feels like, what challenges it poses to living a productive and fulfilling life, and how to manage symptoms and flare-ups. Patient knowledge (“experiential evidence” or “lived experience”) often complements but sometimes conflicts with the professional knowledge of clinicians and academics on guidance development panels. Patient input to guideline panels has contributed to better care experiences and better health outcomes2 but is not without controversy.Most guideline development panels worldwide follow the grading of recommendations assessment, development, and evaluation (GRADE) approach. These methods set out how to assess and combine research evidence by weighting it according to study design, risk of bias, and magnitude of effect.4 GRADE methods are widely accepted but have been described as hierarchical, quantitative, and exclusively focused...

Pluripotent stem cells, such as embryonic stem cells, are characterised by their capacity for self-renewal and differentiation into nearly every cell type within the human body. In 2006, Shinya Yamanaka pioneered the development of induced pluripotent stem cells (iPSCs) by introducing specific genes, now known as Yamanaka factors, into somatic cells.1 iPSC technology enables the generation of autologous or HLA-matched cells and tissues, and iPSCs quickly emerged as a promising source for cell-based regenerative medicine.

iCEPS transplantation for LSCD was found to be safe throughout the study period. A larger clinical trial is planned to further investigate the efficacy of the procedure.

A health scandal in which newborn babies were allowed to die for profit has cast a harsh light on Turkey’s growing reliance on private hospitals.Eleven private hospitals in and around Istanbul have been permanently closed as part of the “newborn gang” (yenidoğan çetesi) scandal, which has dominated Turkish headlines for three weeks. On 18 November, 47 people will stand trial on charges including negligent homicide, fraud, and forgery. Prosecutors are asking for sentences of 589 years for the alleged ringleaders—two doctors and an ambulance worker.Seventeen of those charged are nurses and 14 are doctors, including the chief physicians of six hospitals. Five more are hospital directors or managers, and one is a hospital owner. The rest are hospital secretaries and accountants, as well as workers at the ambulance and referral services of Istanbul municipality and province.Nine more people have been detained in a separate investigation after the family of the...

Over 100 governments at a United Nations event in Colombia have committed to ending violence against children, including through banning corporal punishment, improving services for the children affected, and investing in parenting support.Nine countries promised to pursue legislation against corporal punishment (Burundi, Czechia, Gambia, Kyrgyzstan, Panama, Sri Lanka, Uganda, Tajikistan, and Nigeria) at the event held in Bogotá on 7 November, hosted by the governments of Colombia and Sweden alongside the World Health Organization (WHO) and Unicef.Dozens of countries also committed to investing in better support for parents, while the UK government said that it would launch a global taskforce on ending violence in and through schools, and the Spanish government announced that it would pursue a new law to promote digital safety.Currently, half of all children worldwide—around a billion—are thought to experience some form of violence, such as maltreatment, bullying, physical or emotional abuse, or sexual violence. WHO estimates...

by Michael R. Whitehouse, Rita Patel, Jonathan M. R. French, Andrew D. Beswick, Patricia Navvuga, Elsa M. R. Marques, Ashley W. Blom, Erik Lenguerrand

Background

The risk of re-operation, otherwise known as revision, following primary hip replacement depends in part on the prosthesis implant materials used. Current performance evidences are based on a broad categorisation grouping together different materials with potentially varying revision risks.We investigated the revision rate of primary total hip replacement (THR) reported in the National Joint Registry by specific types of bearing surfaces used.

Methods and findings

We analysed THR procedures across all orthopaedic units in England and Wales. All patients who received a primary THR between 2003 and 2019 in the public and private sectors were included. We investigated the all-cause and indication-specific risks of revision using flexible parametric survival analyses to estimate adjusted hazard ratios (HRs). We identified primary THRs with heads and monobloc cups or modular acetabular component THRs with head and shell/liner combinations.A total of 1,026,481 primary THRs were analysed (Monobloc: n = 378,979 and Modular: n = 647,502) with 20,869 (2%) of these primary THRs subsequently undergoing a revision episode (Monobloc: n = 7,381 and Modular: n = 13,488).For monobloc implants, compared to implants with a cobalt chrome head and highly crosslinked polyethylene (HCLPE) cup, the all-cause risk of revision for monobloc acetabular implant was higher for patients with cobalt chrome (hazard rate at 10 years after surgery: 1.28 95% confidence intervals [1.10, 1.48]) or stainless steel head (1.18 [1.02, 1.36]) and non-HCLPE cup. The risk of revision was lower for patients with a delta ceramic head and HCLPE cup implant, at any postoperative period (1.18 [1.02, 1.36]).For modular implants, compared to patients with a cobalt chrome head and HCLPE liner primary THR, the all-cause risk of revision for modular acetabular implant varied non-constantly. THRs with a delta ceramic (0.79 [0.73, 0.85]) or oxidised zirconium (0.65 [0.55, 0.77]) head and HCLPE liner had a lower risk of revision throughout the entire postoperative period.Similar results were found when investigating the indication-specific risks of revision for both the monobloc and modular acetabular implants.While this large, nonselective analysis is the first to adjust for numerous characteristics collected in the registry, residual confounding cannot be rule out.

Conclusions

Prosthesis revision is influenced by the prosthesis materials used in the primary procedure with the lowest risk for implants with delta ceramic or oxidised zirconium head and an HCLPE liner/cup. Further work is required to determine the association of implant bearing materials with the risk of rehospitalisation, re-operation other than revision, mortality, and the cost-effectiveness of these materials.

Long awaited reforms to outdated mental health laws in England and Wales, giving patients more autonomy, have been introduced in the UK parliament.1The first major overhaul of mental health legislation in more than 40 years fulfils a manifesto commitment by the new Labour government. Under the Mental Health Bill, people being detained for mental health reasons will no longer be allowed to be held in police or prison cells. There will be a limit on the length of time people with autism or learning disabilities can be detained unless they have a co-occurring mental health condition.Patients will have care and treatment plans tailored to their individual needs. They will be given the right to select a person to represent their interests and greater access to advocacy when detained. Doctors will be required to consult with the people close to patients when making decisions about their care.Wes Streeting, the health and...

On 24 June 2022, the Supreme Court of the United States overturned Roe v Wade and revoked the constitutional right to abortion. Following the Dobbs decision, control of abortion policies was returned to individual states. The election on 5 November further degrades hope for progress in women’s health. With Donald Trump now the president-elect, a federal abortion ban is likely, and even access to in vitro fertilisation and contraception may be at risk.1Many political and moral problems exist with a male dominated court and political party deciding who can make decisions about women’s reproductive autonomy. But as a healthcare professional in obstetrics and gynaecology, what concerns me most is the court’s limited view of what is at stake here: the ability to keep pregnant women healthy. Abortion is completely banned in 13 states and heavily restricted in others. This removes far more than access to the narrow definition of abortion...

Donald Trump’s re-election to the US presidency will mean changes to healthcare, reproductive rights, and effects of climate change in peoples’ lives, in addition to the worries about inflation and immigration that motivated many to vote.12Nothing is known about Trump’s own health because he did not release his medical records. He is 78 and will take office in January 2025.Changes will be made possible because of election gains by the Republican party, Trump’s promises, and decisions by the US Supreme Court, which has a conservative majority because of the three justices he appointed during his first term as president (2017-21).Republicans gained control of the Senate and seem likely to gain control of the House of Representatives when all votes are counted, giving Trump unusual power. More often presidents need to negotiate with a Senate or House controlled by the opposing party.Senate approval is needed for presidential appointments of cabinet members,...

“Have you ever seen a dead body?” This was the only question I was asked by the autopsy technician before witnessing my first postmortem examination. It was a difficult one to answer. I had seen cadavers in anatomy rooms before, and even dissected them, but I had never seen a recently deceased person. I decided to say that I had, and with my psychological preparation deemed sufficient, I went into the examination room.Observing a postmortem examination was presented to me as a fantastic way to gain a close understanding of human anatomy in a more immersive setting and to appreciate pathologies in their entirety. But the lack of information I was given about the technical practice of the examination meant that I was too shocked to take in much of the anatomy shown to me. It was a privilege to be able to observe, but receiving a detailed brief in...

In this paper by Hirt and colleagues (BMJ 2024;385:e078384, doi:10.1136/bmj-2023-078384, published 9 May 2024), a small error in recommendation 5 of the TARCiS statement has been corrected.